Observational study on the timing and method of interruption by hospital consultants during the opening statement in outpatient consultations

OBJECTIVE: To analyse verbal interruptions by Dutch hospital consultants during the patient’s opening statement in medical encounters. DESIGN: Cross-sectional descriptive study. SETTING: Isala teaching hospital in Zwolle, the Netherlands. PARTICIPANTS: 94 consultations by 27 consultants, video recorded in 2018 and 2019. MAIN OUTCOME MEASURES: Physicians’ verbal interruptions during patients’ opening statements, rate of completion of patients’ opening statements, time to first interruption and the effect of gender, age and physician specialty on the rate and type of physicians’ verbal interruptions. RESULTS: Patients were interrupted a median of 9 times per minute during their opening statement, the median time to the first interruption was 6.5 s. Most interruptions (67%) were backchannels (such as ‘hm hm’ or ‘go on’), considered to be encouraging the patient to continue. In 52 consultations (55%), patients could not finish their opening statement due to a floor changing interruption by the consultant. The median time to such an interruption was 31.4 s, on average 20 s shorter than a finished opening statement (p=0.004). Female consultants used more backchannels (median 9, IQR 5–12) than male consultants (median 7, IQR 2–11, p=0.028). CONCLUSIONS: Hospital-based consultants use various ways to interrupt patients during their opening statements. Most of these interruptions are encouraging backchannels. Still, consultants change the conversational floor in more than half of their patients during their opening statements after a median of 31 s.